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describe acute renal failure in terms of cause treatment and outcome
- acute renal failure is rapid decline in kidney function
- can be prerenal,intrarenal,postrenal
- 80-95% pre or intrinsic
- if treated early, kidney function may be restored
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differentiate prerenal failure in development and manifestation
prerenal decreases perfusion of kidneys, most common, hypovolumia,afferent vasoconstriction, blood flow down below 25% ishemia, elevated BUN to creatinine
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differentiate intrinsic failure in development and manifestation
- results from damage to kidney structures,
- ATN - tubular epithelial, from sepsis or hypovolumia
- from toxic insult, tubular obstruction or ischemia
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differentiate postrenal failure in development and manifestation
- results from obstruction of urine outflow,
- ureter, bladder, or urethra (prostatic hyperplasia)
- usually must be bilateral to cause failure
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cite two main causes of ATN and describe the three phases
- destruction of tubular epithelial cells,
- caused by toxic,ischemia,sepsis,obstruction or infection
- onset or initiation - time of event to tubular injury
- maintenance - decreased GFR, retention,edema,oliguria
- recovery - repair of renal tissue,increase in urine output,
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most common cause of chronic kidney disease
hypertension then diabetes
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describe the five stages of chronic kidney disease
- CKD is kidney damage or GFR<60 for 3 months or longer
- 1-kidney damage GFR>=90
- 2 - kidney damage GFR 60-89
- 3 - GFR 30-59
- 4 - GFR 15-29
- 5 - FAILURE GFR < 15 or dialysis
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describe the methods used for an accurate GFR and rationale for its use
- normal GFR 120-130
- serum creatinine or 24 urine creatinine
- increase in Albuminuria
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what causes fluid and electrolyte imbalance in CKD?
- inability to concentrate urine,
- inability to regulate sodium,
- hyperkalemia develops late
- acidosis due to decreased H+ excretion and bicarb reabsorbtion
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what causes disorders of skeletal and hematological in CKD?
- abnormal Ca and Ph occur early
- serum Ph rises due to lack of excretion thus,
- Ca levels fall, PTH rises, demineralization, reduced activation of Vitamin D
- anemia due to decreased EPO, blood loss, low iron, and blood urea
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what causes cardiovascular and immune disorders in CKD?
- hypertension due to increased fluid, renin-angiotensin, possible uremic pericarditis
- immune and inflamation can be limited by blood urea
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what causes neurologic, skin, and sexual dysfunction in CKD?
- uremia can demylenate cause neuropathy
- uremia can affect CNS
- skin can be pale due to anemia,dry skin,itching
- sexual from neural,hormonal,and drugs used to treat
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state the basis for adverse drug reactions in patients with CKD
- many drugs and metabolites are elimnated by the kidney,
- decreased albumin means more drug is free to act
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what are the principles of dialysis and difference between hemodialysis and peritoneal dialysis
- blood delivery system
- dialyzer - artificial tubular filter takes blood cells and proteins, substances can be added
- dialysis fluid delivery system, to arteriovenous shunt
- peritonal dialysis - dialyzing solution added to the peritoneal cavity, dwells for osmosis then is drained
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possible complications of kidney transplant?
histocompatibilty, adequate organ preservation, and immune management. immunosupressants given,
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goals for dietary management in persons with CKD?
- restriction of dietary proteins descreases breakdown to BUN and acids
- limitation of sodium and fluid
- limit phosphorus intake
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causes of CKD in children and special problems
- children < 5yo - congenintal malformation
- children > 5yo - aquired and inherited disorders
- special problems with growth and development
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why is CKD more common in elderly, what can prevent this?
- normal aging decreases GFR
- secondary disease causes of CKD more common
- secondary diseases can be treated and nephrotoxic drugs can be avoided
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treatment of CKD in children and elderly
- children - transplant,dialysis,
- elderly - different monitoring standards due to decreased muscle mass, individualized hemodialysis, decreased transplants with age
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what is the difference between acute and chronic kidney failure/disease
- acute-abrupt in onset, often reversible if recognized early and treated appropriately
- chronic-end result of irreparable damage to kidneys, develops slowly
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What is the difference between prerenal, intrinsic and postrenal causes of kidney failure?
- prerenal - decreased renal perfusion
- intrinsic-damage to structures within kidney
- postrenal-obstruction of urine outflow from kidney
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congestive heart failure what be a _______ cause of renal failure?
prerenal
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common causes of CKD
- hypertension
- diabetes mellitus
- polycystic kidney disease
- obstructions of urinary tract
- glomerulonephritis-autoimmune,strep,empitigo
- cancers-renal cell, urolithial
- autoimmune disorders - ESL
- Disease of heart or lungs - CHF
- chronic use of pain medication
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treatment during renal insufficiency phase of renal failure
- prompt treatment of UTI - prevent pyelonephritis
- avoid nephrotoxic medication
- control blood pressure
- control blood sugar in diabetes
- stop smoking
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how does high blood pressure make CKD worse?
thickens basement membrane, kidney becomes less compliant
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Clinical manifestations of CKD
- accumulation of nitrogenous wastes
- alterations in fluid electrolyte balance
- mineral and skeletal disorder
- anemia and coagulation disorder
- GI disorders
- hypertension and cardiovascular disorder
- neurologic complications
- disorders of skin integrity
- immunologic disorder
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